LONDON — The final defendant has pleaded guilty in a large drug case that gave police new insight into interstate pill smuggling, which has grown to worrisome proportions in Kentucky the past few years.

The case involving Lloyd Stanley Naramore was the first in which police could track pills sold illegally in Eastern Kentucky to a doctor writing the prescriptions in another state, said Capt. Kevin Payne, commander of the state police Special Investigations/Drug Enforcement unit for the eastern half of the state.

Naramore, 64, formerly a Cincinnati osteopath, pleaded guilty Monday to a federal charge of conspiring to distribute methadone. He could receive up to 20 years in prison when he is sentenced in March.

He also agreed to forfeit $100,000 to the federal government.

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Naramore was charged as part of a conspiracy with Timothy Wayne Hall, a Floyd County man who admitted he arranged for scores of people from Eastern Kentucky to get prescriptions from doctors in other states, then bring pills back to Kentucky to abuse and sell.

More than 100 people from Pike and Floyd counties went to Naramore's office — about four hours one way — to get prescriptions, according to his plea agreement.

Naramore and more than 20 other people in the case have pleaded guilty.

The case helped officers in Kentucky learn about interstate pill smuggling, Payne said — issues such as whether doctors require examinations, whether they operate on a cash-only basis, and the difficulties in getting access.

"This was our first opportunity to really get our teeth in it," Payne said.

More addicts and drug dealers began leaving Kentucky to get pill prescriptions in recent years to avoid scrutiny by the state's electronic prescription-monitoring system, police have said.

Florida has been a key destination because it has a lot of pain clinics and no prescription monitoring system.

Payne said police had known even before the case involving Hall and Naramore that people were bringing pills into Kentucky.

In that case, however, police identified the source — an Urgent Care clinic in Philadelphia, according to a court document.

Police in Kentucky learned through authorities in Pennsylvania that a large number of Kentucky residents were showing up in Philadelphia. Randy Hunter, a Kentucky State Police detective, and Donnie Kidd, an FBI agent, took the lead in unraveling the conspiracy, Payne said.

Randy Weiss, an osteopath who worked at a Philadelphia clinic, pleaded guilty earlier this year to prescribing pain pills to Hall and others from Kentucky without a legitimate medical purpose.

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In early 2006, representatives of Urgent Care, a Louisiana company, recruited Naramore to work at a pain clinic the company planned to open in Cincinnati, according to a court document.

A number of the Eastern Kentucky residents who went to the Cincinnati clinic had earlier been going to the company's office in Philadelphia, Naramore said.

Urgent Care officials told Naramore to accept only cash for office visits — $400 for each monthly visit — and one refused to provide even basic equipment such as blood-pressure machines, according to a court document.

One of the officials, identified only as Michael L., told Naramore to prescribe methadone and Percocet, another pain pill, to people who came to the clinic.

Naramore did not think those medications were medically necessary for many of the people, but he wrote the prescriptions "for fear of losing his income from the position" — $3,000 a week, according to his plea agreement.

Naramore knew there was a good chance the people he was helping get pills were selling them illegally but "deliberately closed his eyes to what was obvious," he acknowledged in the plea document.

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